It’s 2018, and the world looks much different than it did a year ago. Go back even further and the differences are even starker. No place is that more evident than in healthcare. As the largest industry in the world, healthcare has weathered the most significant political waves of the last fifteen years. As the costs of healthcare increased unchecked, politicians took notice.

In our pseudo free-market health system, where a considerable portion of costs are covered with public funds, and where the largest public payor initiates changes that are then emulated by commercial payors and, likewise, where government entities heavily regulate healthcare’s techniques and technologies, politicians have intervened to force changes. With healthcare being a major topic of the last several elections and a top priority for President Obama during one of his two terms (as it was for President Clinton, though his primary initiatives in healthcare didn’t pass), it’s no surprise that the current administration also would like to impart change. President Trump is now working to alter some of what the Obama administration put into place. This move creates more uncertainty and requires change. I think everyone agrees on a defined set of goals for the industry, known as the triple aim (better outcomes, lower costs, improved experience), but the path to achieving those goals is wildly variable depending on your political position.

Unfortunately, these required changes have placed the industry in turmoil. In an effort to modernize its technology, EHRs have been forced between providers and patients to ensure better, more consistent data collection. Ideally, this move should reduce medical errors and redundant tests, however, the government missed a massive opportunity here when it spent north of $40B on incentives to increase digitization of medical records — EHR software that wasn’t built to reduce medical errors, unnecessary tests or even improve clinician communication or data sharing across providers that would ensure continuity of care. At the same time, government financial incentives prompted a change to healthcare services to ensure quality. Yet, most of these quality initiatives didn’t go far enough and consequently increased data reporting burdens for clinicians. Meanwhile, payments for the majority of healthcare services have been reduced, squeezing provider margins and changing the rules for how providers are paid.

Healthcare hasn’t improved for consumers. During appointments, providers struggle to connect because they have screens, not patients, in front of them. Insurance coverage has gotten worse; choices have been reduced and the complexity of bills and payor communications to consumers more complex. How much worse have things become? I have an MD, MBA, and MS. I run a healthcare company with ~50 employees and have been writing and speaking on healthcare and healthcare technology for ten years. My wife and many of my friends are practicing physicians; some are my physicians. Yet, I woefully struggle to understand my medical bills, choices in providers, and generally how to navigate our broken system.

Where does that leave healthcare going into 2018? I’d argue that healthcare, if anything, is worse today than it was a year ago. The government, individuals, and private sector will certainly continue pushing for more changes in 2018. Given that, I predict we’ll see a few major healthcare trends as we move through the new year.

Subscription / direct pay / cash-based practices

Consumers, with minimal choice in healthcare, find it difficult to speak with their wallets or their feet. Similarly, providers have even fewer options. It’s no wonder that subscription medicine and cash-based medical practices are growing in popularity for both providers and patients (more on that below). These care models align incentives and are transparent. Geared towards those who have the ability to pay extra for better services, today, the majority of these care models bank on the pocketbooks of the middle to upper class. However, emerging data sets show the success of this model is also possible for underserved populations, as well. Learn more about what I think will happen with cash-pay practices in 2018.

Post-EHR healthcare

The gravy train of meaningful use (MU) is over. The effect of MU was a significant, artificial, driver of adoption for a few EHRs. Today, digital health records are the standard. As we move through 2018, keep an eye on EHRs and how they justify their ROI once massive capital expenditures are written down. Likewise, you’ll want to consider how clinicians adjust to this brave new world. Read more about my 2018 predictions for the post-EHR world.

Clinicians as developers

The EHR wave of health IT left out clinicians. EHR and IT vendors drove those early technology decisions. Now, with software eating the world, clinicians are acting like software developers and corporate innovators in helping to design and, in some cases, build new technology and technology-enabled services for their colleagues and their patients. Read more of my thoughts on clinicians as developers.

The real cloud

HIMSS 2018, the largest health technology conference on the planet, will for the first time see the behemoth booths of EHR vendors challenged by the equally massive booths of public cloud service providers like Amazon, Microsoft, and Google. This is the canary in the coal mine moment for healthcare, not just for the adoption of the real cloud over simple virtualization, but also in the fragmentation of infrastructure and services managed by third parties for healthcare delivery organizations. Learn more about the real cloud in healthcare.

Beyond digital health hype

Digital health has been hyped for a long time as a savior for healthcare. Unfortunately, healthcare is not that simple and no savior exists to untangle us from our current mess of a system. Technology, for technology’s sake, is not going to fix healthcare. While we’ve witnessed incredible enthusiasm around new technologies disrupting healthcare, we’re also now seeing some public failures, like the recent acquisition/fire sale of Practice Fusion, or the Castlight Health initial public offering hype and valuation assumptions compared to the market reality of today. Similar to EHRs, digital health now must prove it’s worth if it’s going to have sticking power. Find out more about getting beyond the digital hype.

Blockchain to the rescue

Speaking of hype, blockchain has made its way into healthcare. Smart contracts, immutability, and a clear audit trail — hallmarks of blockchain technology — hold much promise for healthcare data and exchange. The problem is that technology, especially when it comes to data sharing and interoperability in healthcare is not the dominant roadblock. Layering in new technology, like blockchain, leaves the fundamental organizational and political problems unsolved.

I’ll focus on each of these trends in subsequent posts, distilling all of these healthcare trends down into one larger narrative: post-EHR healthcare is finally ready and incented to start making the necessary changes that will align with the triple aim. Massive organizations will vie for their place in this new healthcare world; some will win and others won’t. The winners will be the providers AND the patients.

Venture capital for the digital health market is still holding its own, keeping pace with last year's "record-breaking growth," according to a new report from digital health startup accelerator Rock Health.

In fact, this year's Q2 raked in $2.1 billion from investors for digital health startups, just shy of last year's mid-year number which reached $2.3 billion.

"Now at the half-year mark, investors have spoken," wrote Malay Gandhi, managing director at Rock Health, in a July 6 post, unveiling the numbers. "Digital health isn't slowing down."

Although the number of deals were fewer than last year at this time – 139 deals in 2015 compared to 146 in 2014 – the average deal size was $400,000 bigger this time around.

One of the big changes this year was around the most funded digital health category. Last year, the winner was payer administration startups, which collectively scored $211 million. This year, wearables and biosensing companies walked away with the lion's share of funding, at $387 million. However, San Francisco-based wearable company Jawbone accounted for $300 million of that pie.

Analytics and big data came in at No. 2 for most funded digital health category, bringing in $212 million by mid 2015. That represents a $16 million increase in this category from last year's numbers. Salt Lake City-based analytics startup Health Catalyst brought in $70 million.

According to another digital health accelerator StartUp Health's mid-year report, however, analytics and big data came in third place, below wellness/benefits and patient/consumer experience. The company bills itself as the world's largest portfolio of digital health companies.

One category in Rock Health's report that failed to emerge as top theme last year – EHR and clinicalworkflow – brought in $74 million this time around. One of those startups, the San Francisco-based Augmedix, which integrates Google Glass with the electronic medical record, earned $16 million of that.

This year, Rock Health officials also tracked digital health IPOs, which "outperformed" S&P 500 by the end of Q2.

"Coming off a record-smashing year for digital health funding, where dollars into the space totaled more than 8 percent of all venture funding, it would not have been surprising if 2015 was a letdown," Rock Health officials wrote in the 2015 mid-year report. "However, 2015 has more or less kept pace with 2014."

But this growth, as they explained, also comes with a drawback. And that's "noise." In other words, it's a tough, saturated market, with a record number of digital health companies "vying for the attention of both the industry and the consumer."

In the 1990s, it was the Internet. In the early 2000s, it was about mobility. Now, it's the era of "living services." At least that's according to Accenture officials, who citing their new report published June 15, say organizations – including healthcare organizations – will be soon providing a "new wave of transformative digital services."

And the one area where this wave will appear first? It's the healthcare industry, officials point out. Think quantified self-health tracking devices. Think wearables and mobile health platforms that are helping consumers manage myriad chronic diseases and wellness.

"We call them 'living services' for three reasons," said Brian Whipple, senior managing director for Accenture Interactive, in a June 15 press statement announcing report findings. "They will change consumer experiences," he continued. "They will be driven by things that are very proximate to us such as wearables and nearables. And, at the human level, living services will affect our lives in a much deeper and more positive way than mobile and Web services have."

As Mark Curtis, chief client officer of Fjord, Accenture Interactive’s design and innovation group, described, we’re still very much in the mobile era now. "But this third era is "really coming at us very fast now."

That era of living services is composed of what Curtis explained as first the "digitization of everything" and second, what they call "liquid expectations." And understanding this part just may be key for the healthcare industry – and something it's not quite used to.

"Liquid expectations are the process by which what we're now seeing in digital is that customers are having an experience over here. They're enjoying that experience, and they are then transferring their expectations for what best experiences should be across industry barriers," said Curtis. "What that means is that…now you need to be looking long and hard at what people are doing in completely different industries." And that includes health, he added.

Described in the Accenture report as the "healthcare revolution," officials say healthcare living services will be fueled by the movement of the "quantified self," that is, the increasing awareness of one's health and technology advances that now allow people to monitor health in myriad ways.

The report cites many apps and platforms becoming more and more prevalent. One smartphone application, being developed by folks the University of Michigan, for instance, monitors a user’s voice to detect mood changes for individuals with bipolar disorder.

"Through smart mobile technology, individualized healthcare can be administered more efficiently and more effectively," officials concluded.

The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.

This is the year the promise of telehealth will be realized. It is projected that by 2018, 65 percent of interactions with health organizations will take place via mobile devices. Those statistics speak to the need of satisfying the growing demands being placed on providers, along with the growing discernment among patients when it comes to selecting affordable and convenient medical services. The continued adoption of telehealth will extend the point of care for providers and provide ubiquitous access to medical professionals for patients.

A number of entities are already putting this into practice: Walgreens, in partnership with MDLIVE, recently expanded their mobile platform to offer virtual doctors visits for acutely-ill patients; Google is testing a HIPAA-compliant medicine platform for video chats with doctors; and, digital urgent care solutions, like Doctor on Demand, are growing in popularity due to their convenience and low cost.

Telemedicine will not only extend the point of care, but will also be critical in better combatting chronic disease. Managing chronic health conditions will become the focus of many healthcare providers, as models of reimbursement and population health management (PHM) continue to replace fee-for-service models. One issue with chronic disease management is that it is difficult to monitor at-risk patients outside of the hospital. This is where telemedicine comes in.

For example, our client UCSF uses devices like step trackers, sleep trackers, scales and blood pressure monitors to track patients at-risk for heart disease or cardiac readmissions. Another client, UNC is creating a Gastro-Intestinal tracking application (GI Buddy) that leverages fitness devices and scales to monitor Chron’s disease. There are thousands of studies pioneering innovations to improve the efficiency and effectiveness of healthcare. And, they are making serious strides.

The automatic transmission of pertinent patient data from these mobile health technologies is propelling forward capabilities for cost-effective, efficient and successful remote patient monitoring, population management and patient engagement programs.

However, as telehealth and telemedicine capabilities continue to develop, the major hurdle for most providers is integrating and the mobile health data collected outside of the hospital back into the clinical story for use in the provision of care. In a value-based healthcare system, the key to better outcomes lies in data, and specifically, obtaining access to data generated outside of the provider setting.

Platform services will continue to be vital partnerships as healthcare systems are expected to quickly execute on all these initiatives simultaneously and successfully. Bottom line: The industry is transforming, and if you have not started talking about how to connect to those external data sources, then you need to start.

These emerging trends will continue to bind the landscapes of technology, healthcare, and business. The road set upon long ago by medical professionals and legislators is finally coming to fruition. The walls of interoperability are beginning to come down, investments are growing, partnerships are forming, and consumers are starting to take notice. We are moving towards a digital health revolution. We have the opportunity, the responsibility, and the honor, to align healthcare and technology innovation to exponentially improve our care system. It is a tall task, but we are off to a promising start.

While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.

The mainstream healthcare consumer in 2014 embraced the ALS Ice Bucket challenge and panicked (rightfully so) about the staggering wake-up call of the Ebola outbreak. While the politicians in US played the Obamacare ping pong game, and Brussels accepted its first applications for eHealth projects as part of Horizon 2020, there was also a major undercurrent in how digital health and health IT have penetrated our everyday lives.

In the US alone, digital health funding more than doubled from 2013, according to RockHealth, and even almost tripled according to StartupHealth. While the delta is not a rounding error, the key point is the exponential trajectory that showcases the fact that smart money believes this industry is ripe for significant disruption.

There are still many companies and investors that are sitting on the sidelines and watching the show from the balcony. As an example, there are many critics of wearable devices and even some hesitations on the value of big data. But, I want to remind everyone that Rome was not built in a day and the first generation or even second generation of devices, big data platforms, and decision support tools will improve care mainly driven by healthcare entrepreneurs, healthcare consumers and passionate scientists and clinicians – the “stormchasers”.

On February 2nd, I attended a local Singularity University lecture with a keynote from Gerd Leonhard, who is a thinker, futurist and a digital heretic. One of the statements he made really resonated with me: “Technology is exponential, humans are not”. The keynote was all about ethics in the age of exponential technology. But, leaving privacy and ethical issues aside, 2015 will be a pivotal year for digital health in an era of exponential technology:

1. Precision medicine

During the State of the Union Address, President Obama announced the precision medicine initiative.

"I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time. In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier."

Precision, or personalized medicine, (I use the term interchangeably) is an approach to using medical and genetics data, body-generated data, biotechnology, and science, to first and foremost understand the root causes of the disease—but also come up with personalized and individualized treatments and therapies.

Due to forthcoming government funding, but more importantly smart money and brilliant entrepreneurs, we will certainly see more activity this year. After all “Health IS Personal”.

"The techniques for researching and characterizing genomics diseases are available to both researchers (next generation DNA sequencing) and the general public (in the form of personal testing), so we should soon be able to diagnose any genetic disease by sequencing a patient’s DNA."

Indeed, this is the future but the future is almost here: Illumina with $1,000 per full genome sequencing, Tute Genomics which is now allowing researchers and clinicians to interpret the entire human genome, and a big announcement for 23andMe regarding their entrance into the UK market.

As an industry, there are still a lot of hurdles, but we will see some significant moves this year in this space—including ways to actually analyze 150 zetabytes (1021) of data per full genome, begin integrating this data into evolving and ancient EMR platforms, and provide genetic counseling to offset the lack of knowledge by the masses.

3. Smart Data and Data Science

Well actually, data itself is not smart, people are! And while there is huge promise in big data analysis, collecting and hoarding zetabytes (yes this term again) of data does not bring any value.

People need to ask the right questions of the data. We are at an age where collecting data is easy with body-generated data, environmental data, and traditional medical data—but it is the data scientist combined with sharp business and clinical skills that will empower the healthcare system to make all this data actionable, with the healthcare consumer at the center.

"If you torture the data long enough, it will confess to anything" - Ronald Coase

4. Next Generation EMR is personal

Let’s face it—and this is not news to anybody—core medical data is already becoming a small percentage of the overall personal health record. Existing EMR platforms are over two decades old and some are struggling to keep up with archaic architectures, millions of lines of code, and minimal-to-no differentiation to their client base today.

The smart ones are looking to open up their APIs, integrate body-generated and genomics data, and even combine that with environmental data at a personalized level to be able to provide that precision medicine at point of care.

5. Design and Aesthetics

Our bodies are complex, and therefore the medical profession is complex. Once again, an unprecedented amount of content is generated daily—and for both consumers and clinicians alike, dealing with this information overload is becoming yet another full time job.

The aforementioned smart data discussion is only one piece of the puzzle. User experience is another.

At the core of our health is human behavior. Hence, incentivizing healthcare consumers (patients), making their treatment pathways clear, and presenting stupid data in a smart and actionable way are all key to improving our healthcare system.

Global health care transformation is still in its infancy. While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.

I think it’s fair to say that digital health is warming up. And not just in one area. The sheer number and variety of trends are almost as impressive as the heat trajectory itself. The scientist in me can’t help but make the connection to water molecules in a glass — there may be many of them, but not all have enough kinetic energy to ascend beyond their liquid state. The majority are doomed to sit tight and get consumed by a thirsty guy with little regard for subtle temperature changes.

With this in mind, let’s take a look at which digital health trends seem poised to break out in 2015, and which may be fated to stay cold in the glass. As you read, keep in mind that this assessment is filtered through my perspective of science, medicine, and innovation. In other words, a “cold” idea could still be hot in other ways.

Collaboration is hot, silos are not. Empowerment for patients and consumers is at the heart of digital health. As a result, the role of the doctor will shift from control to collaboration. The good news for physicians is that the new and evolved clinician role that emerges will be hot as heck. The same applies to the nature of innovation in digital health and pharma. The lone wolf is doomed to fail, and eclectic thinking from mixed and varied sources will be the basis for innovation and superior care.

Scanners are hot, trackers are not. Yes, the tricorder will help redefine the hand-held tool for care. From ultrasound to spectrometry, the rapid and comprehensive assimilation of data will create a new “tool of trade” that will change the way people think about diagnosis and treatment. Trackers are yesterday’s news stories (and they’ll continue to be written) but scanners are tomorrow headlines.

Rapid and bold innovation is hot, slow and cautious approaches are not. Innovators are often found in basements and garages where they tinker with the brilliance of what might be possible. Traditionally, pharmaceutical companies have worked off of a different model, one that offers access and validation with less of the freewheeling spirit that thrives in places like Silicon Valley. Looking ahead, these two styles need to come together. The result, I predict, will be a digital health collaboration in which varied and conflicting voices build a new health reality.

Tiny is hot, small is not. Nanotechnology is a game-changer in digital health. Nanobots, among other micro-innovations, can now be used to continuously survey our bodies to detect (and even treat) disease. The profound ability for this technology to impact care will drive patients to a new generation of wearables (scanners) that will offer more of a clinical imperative to keep using them.

Early is hot, on-time is not. Tomorrow’s technology will fuel both rapid detection and the notion of “stage zero disease.” Health care is no longer about the early recognition of overt signs and symptoms, but rather about microscopic markers that may preempt disease at the very earliest cellular and biochemical stages.

Genomics are hot, empirics are not. Specificity — from genomics to antimicrobial therapy — will help improve outcomes and drive costs down. Therapy will be guided less and less by statistical means and population-based data and more and more by individualized insights and agents.

AI is hot, data is not. Data, data, data. The tsunami of information has often done more to paralyze us than provide solutions to big and complex problems. From wearables to genomics, that part isn’t slowing down, so to help us manage it, we’ll increasingly rely on artificial intelligence systems. Keeping in mind some of the inherent problems with artificial intelligence, perhaps the solution is less about AI in the purest sense and more around IA — intelligence augmented. Either way, it’s inevitable and essential.

Cybersecurity is hot, passwords are not. As intimate and specific data sets increasingly define our reality, protection becomes an inexorable part of the equation. Biometric and other more personalized and protected solutions can offer something that passwords just can’t.

Staying connected is hot, one-time consults are not. Medicine at a distance will empower patients, caregivers, and clinicians to provide outstanding care and will create significant cost reductions. Telemedicine and other online engagement tools will emerge as a tool for everything from peer-to-peer consultation in the ICU to first-line interventions.

In-home care is hot, hospital stays are not. “Get home and stay home” has always been the driving care plan for the hospitalized patient. Today’s technology will help provide real-time and proactive patient management that can put hospital-quality monitoring and analytics right in the home. Connectivity among stakeholders (family, EMS, and care providers) offers both practical and effective solutions to care.

Cost is hot, deductibles are not. Cost will be part of the “innovation equation” that will be a critical driver for market penetration. Payers will drive trial (if not adoption) by simply nodding yes for reimbursement. And as patients are forced to manage higher insurance deductibles, options to help drive down costs will compete more and more with efficacy and novelty.

Putting it all together: What it will take to break away in 2015?

Beyond speed lies velocity, a vector that has both magnitude and direction. Smart innovators realize that their work must be driven by a range of issues from compatibility to communications. Only then can they harness the speed and establish a market trajectory that moves a great idea in the right direction. Simply put, a great idea that doesn’t get noticed by the right audience at the right time is a bit like winking to someone in the dark. You know what you’re doing, but no one else does.

Happy New Year to my HealthBlog readers around the world. I’m back in the saddle after a 3 week hiatus for the holidays. I must say I’m feeling fully rested and looking forward to all that 2015 will deliver.

Like you, I’m getting tired of reading prognostications about what’s hot and not for tech in the year ahead. However, I did enjoy a piece I came across today by my blogosphere colleague and Forbes contributor, Dr. John Nosta. Actually, I believe Dr. Nosta published the post not this week, but rather a full year ago. The post, Digital Heath In 2014: The Imperative of Connectivity, might as well have been written this week as it is just as true today as it was in January of 2014. In it, tech pundits from John Sculley to Steve Wozniak are quoted in musings about the tech revolution in health and healthcare and how everything you know is about to change. As has been true for the past several years, people are predicting massive disruption and transformation of health and healthcare delivery fueled by technology. And, as has been the case during the vast majority of my 14-year career at Microsoft and many years before that as a physician, tech and healthcare industry executive, I feel like I’m still waiting for the big bang.

Now don’t get me wrong, we have certainly seen transformation (albeit slow) of healthcare, and technology is definitely driving a lot of that change. Policy is also driving change, perhaps more so than technology. And, at least in America, no policy is causing more disruption right now than that of the Affordable Care Act. However, all of this begs the question--are things getting better or worse? People are paying more than ever before for the services they receive. Many of us are seeing our health insurance premiums rise while being asked to fork over more and more of our money toward copays and high deductibles (often $5000 to $12,000 per year per family). And even though I love technology, thus far I think it is failing to deliver on its promises or potential. Let me ask you, is it getting easier or harder to pay for and manage healthcare for your family? And if you are a healthcare provider, is it getting easier or harder to take care of your patients the way you’d like to care for them?

Technology should be making all of his easier and less expensive, but is it? Healthcare policy should be doing the same. Instead, we seem to be getting ever more complicated rules, regulations and business practices that confound both consumers and providers alike. Health insurance is more complicated than ever before, and don’t even get me started on Medicare.

If there is a theme I’d like policy makers, tech industry leaders, insurance chiefs, healthcare executives, and clinicians to focus on more on in 2015 it would quite simply be……. simplicity. We are making everything way too complicated. Without greater focus on technology that actually makes things more simple through seamless integration of services and information exchange, improved modalities for synchronous and asynchronous communication and collaboration in clinical workflow, and business models that truly support innovation and lower costs in healthcare, all the fancy new wearable smart devices, labs on a chip and augmented reality headsets won’t do much to save us from our misery.

I believe there are but a few global companies with the breadth, depth, and scale to really deliver on the kinds of information technology advances our health industry needs. Even then, it will take a carefully choreographed dance of enlightened public policy and innovation to deliver the goods. Otherwise, a year from now, and for many years yet to come, we’ll simply be singing more of Auld Lang Syne.

With 2017 almost in the rear-view mirror, it is time to look forward to 2018 and how healthcare will evolve in this year. The last year has been an eventful one for healthcare, from the uproar in healthcare regulations to potential mega-mergers. Needless to say, it’s a time of transition, and healthcare is in a very fluid state- evolving and expanding. There are certainly going to be new ways to keep healthcare providers and health IT pros stay engaged and excited, and here are our top 10 picks:

1. The future of the GOP Healthcare bill

The Republican healthcare reform bill gained immense traction this year. In their third attempt at putting a healthcare bill forward, the senators and the White House officials have been working round the clock to gather up votes, but somehow, the reservations persist. The lawmakers have insisted that Americans would not lose their vital insurance protections under their bill, including the guarantee that the plan would protect those with preexisting conditions. However, as it so happens, even these plans have been put to rest. Perhaps sometime in 2018, the GOP may pass a budget setting up reconciliation for tax reform, and then pass tax reform. Then, they would pass a budget setting up reconciliation for Obamacare repeal, and then pass that- it all remains to be seen.

2. The ongoing shift to value from volume

Despite speculations, healthcare providers, as well as CMS have pushed for more value-based care and payments tied to quality, but it’s been going slow. Although providers have been slightly resistant to take on risk, they do recognize the potential to contain costs and improve quality of care over value-based contracts. And perhaps as data assumes a central role in healthcare, the increasing availability of data and smarter integration of disconnected data systems will make the transition easier and scalable. Notably, with a $3.3 trillion healthcare expenditure this year, there has been slow down the cost growth. 2018 is expected to be much more impactful as it builds on the strong foundation.

3. Big data and analytics translating data into real health outcomes

Big data and analytics have always brought significant advancements in making healthcare technology-driven. With the help of big data and smart analytics, we are at a point in healthcare we can make a near-certain prediction about possible complications a patient can face, their possible readmission, and the outcomes of a care plan devised for them. Not only it could translate to better health outcomes for the patients, it could also make a difference in improving reimbursements and regulatory compliance.

4. Blockchain-based systems

Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare’s longstanding challenge of interoperability and data exchange. Bringing blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of by innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security.

5. AI and IoT taking on a central role

2018 can witness a good amount of investment from healthcare leaders in the fields of Artificial Intelligence and Internet of Things. There is going to be a considerable advancement in technology, making the use of technology crucial in healthcare and assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care.

In December 2016, many were suggesting that wearables were dead. Today, wearables are becoming one of the most sought-after innovation when it comes to digital health. And, the market is quickly diversifying as clinical wearables gain importance and as several renowned organizations integrate with each other. Not only wearables- there are several apps and biosensors that can assist providers with remotely tracking patient health, engage patients, interact with them, and streamline care operations. As technology becomes central to healthcare, 2018 will be the year when these apps and wearables boost the patient-physician interaction.

7. The increasing importance of security

We deal with a tremendous amount of confidential and critical information in healthcare. It’s not just patient health information- it goes from credit card information to digital footprints. As the plethora of devices and systems storing information grows in size, a focus on ensuring becomes extremely vital as a breach could range from something as slight as information being stolen to as dangerous as a person being physically harmed. 2018 may be high time we took a good, hard look at the security of our infrastructure.

8. Payer-provider collaborations

Over the years, healthcare insurers have been stepping into primary care delivery model, encouraging prevention and wellness. At the same time, we have also witnessed the trend of hospitals and healthcare systems getting into the insurance part to take control of the complete patient care process. 2017 saw a lot of merger activity and 2018 will continue to see this synergy focused on value-based care, direct primary care, chronic care management, and patient engagement.

9. Possibly stable healthcare costs

Analysts predict that the healthcare industry will observe a growth of 6.5% in 2018, only half a percentage point higher than in 2017. And, after the changes like copays and network sizes are made to benefit plan design, this growth rate could be as low as 5.5%. Healthcare has long waited for an inflection point, where the spending will take off. But as it so happens, healthcare seems to be settling into a ‘new normal,’ where the fluctuations are more attuned and the growth rate remains in a single digit, with providers seeking strategies that would improve care management, optimize resource utilization and bring the costs down.

10. The future of ACA

There have been several debates and speculations regarding the future of the Affordable Care Act. With a new GOP healthcare bill on the cards, some things will stay the same, but with differences- people can still sign up on healthcare.gov, but the sign-up period would be shorter. They can still get subsidies to help lower their premiums or reduce their deductibles and copays, but some plans will be much more expensive. The future of ACA is still cloudy, and the attempts to repeal and replace ACA have been laid to rest, for now, but one thing is certain- a lot fewer people will enroll for ACA in 2018, fearing a repeal.

This is definitely an amazing time in the digital health world. There may be complexities and uncertainty, but for any healthcare system deeply passionate about realizing data-driven outcomes, looking for technology that can drive their core processes and help them win with value-based care- 2018 will be the year!

Healthcare executives expect that, within the next three years, their industry will need to focus as much on training machines as they do on training people, according to a new report by the New York City-based Accenture.

The industry report, “Accenture Healthcare Technology Vision 2015,” is based on a survey of 601 doctors, 1,000 consumers and 101healthcare executives, and highlights emerging technology trends that will affect the health industry in the next three to five years.

Roughly four-in-five (84 percent) health executives agree or strongly agree that their industry will need to focus as much on training machines—such as using algorithms, intelligent software and machine learning—as they do on training people in the next three years. In fact, most of those surveyed (83 percent) agree that provider organizations, driven by a surge in clinical data, will soon need to manage intelligent machines as well as employees.

Intelligent machines will also support the surge in health data from various disparate sources, such as diagnostic tests, internet-connected devices, genomics and medical records. In fact, access to large volumes of new patient data is driving some challenges, as the survey found 41 percent of health executives said their data volume has grown more than 50 percent last year. This data explosion, accompanied by advances in processing power, analytics and cognitive technology, is fueling smarter software that makes it easier to turn big data into better decisions and better healthcare. Approximately half of the healthcare executives surveyed said they use rule-based algorithms (59 percent of respondents), machine learning (52 percent), intelligent agents (49 percent) and predictive analytics (45 percent) to infuse intelligence into systems.

Beyond turning massive amounts of new data into insights, this wave of new technology will create a single platform for data generated by patients, doctors and clinicians. Patient-generated data is already demonstrating benefits among health executives, as nearly three-fourths (73 percent of respondents) have seen positive ROI from their investment in these technologies, such as wearables tracking an individual’s fitness and vital signs. In addition, Accenture found that most physicians (85 percent) believe that wearables improve a patient’s engagement with their own health, while three-fourths (76 percent) of patients believe that wearables have the potential to help them better manage their health and potentially improve it. This is also why health monitoring is the top reason more than half (54 percent) of patients use smartphone applications.

“As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks,” Kaveh Safavi, M.D., who leads Accenture’s health business, said in a statement. “The digital revolution is also creating a data goldmine that can spark medical breakthroughs and improve individualized treatment plans.”

Here’s some research which suggests that a lack of “medical grade” digital health tools is perhaps the final obstacle holding healthcare back adopting them full scale — and reaping the benefits.

Accenture released a study last week concluding that FDA-regulated digital health solutions should save the U.S. healthcare system more than $100 billion between now and the next four years.

The scant number of digital health solutions the FDA has already approved has already had a meaningful impact, generating $6 billion in cost savings last year courtesy of improved med adherence, fewer ED visits and digitally-supported behavior changes, Accenture reports.

But that’s just a drop in the bucket, if Accenture is right. The consulting firm expects our health system to save $10 billion this year thanks to use of such devices. And then, as the FDA approves more digital health technology, the savings figure should make dramatic jumps over the next few years, hitting $18 billion in ’16, $30 billion in ’17 and $50 billion in ’18.

What’s intriguing about these numbers is that they assume each FDA approval will seemingly generate not only more savings, but also a cumulative “whole is greater than the sum of its parts” effect.

After all, in raw numbers, the number of devices Accenture is relying on to achieve this effect is small, from 33 approved last year to 100 by the end of 2018. In other words, 67 devices will help to generate an additional $44 billion in savings.

That being said, what makes Accenture so sure that the ever-so-slow FDA will approve even 70-odd devices over the next few years?

* Provider demand: At present, about one-quarter of U.S. doctors “routinely” use tele-monitoring devices for chronic disease management, researchers found. As hospitals and medical practices look to integrate such solutions with their core EMR infrastructure, they’ll look to please providers who want digital health tech they can trust.

* Reimbursement shifts: Accenture argues that as value-based reimbursement becomes more the norm, health leaders will increasingly see digital health solutions as a means of meeting their goals. And medical device providers will be only to happy to provide them.

* Regulatory conditions: With FDA guidelines in place specifying when wellness tools like heart rate monitors become health devices, it will be easier for the FDA to speed up the process of digital health technologies, Accenture predicts. This should support 30% annual growth of such solutions through 2018, the study found.

* Consumer health tracking: Consumer demand for health tracking devices, especially wearables, should continue its rapid expansion, with the number of consumers owning a wearable fitness device to double from 22% this year to 43% by 2020, according to the consulting firm.

While Accenture doesn’t address the impact of digital health tech that doesn’t get FDA approval, there’s little doubt that it too will have a significant impact on both health outcomes and cost savings. Ultimately, though, it could be that it will take an FDA seal of approval to get widespread adoption of such technologies.

As digital health becomes more of a reality, a recent survey of over 2,000 US adults finds that most of us -- 84 percent to be exact -- see doctors who provide patient online portals.

One of the survey's most surprising findings is that 61 percent of older adults -- aged 55 and up -- access their health information through the portal, while just 45 percent of their younger counterparts in the 18 to 54 age group do so.

The survey found that 37 percent of those who own a wearable fitness tracker wear it everyday.

Of wearable users, 78 percent who use their devices more than once a month say it's practical for their doctors to access that information.

Sixty-four percent of adults would choose telehealth visits over in-person visits at least some of the time, especially for follow-up visits and for minor concerns such as eye infections and skin checks.

More than one quarter, or 27 percent said they would always choose a telehealth visit instead of an in-person visit.

Of parents with children under the age of 18 living under their roof, 76 percent said they would sometimes choose telehealth visits, whereas only 61 percent of those without children under the age of 18 said they would.

Sixty percent of respondents said they would use the online portal for appointment scheduling if it wasn't already available for this purpose.

The survey was conducted by eClinicalWorks, which also surveyed a group of 2,922 US healthcare professionals separately.

Seventy-five percent of healthcare professionals surveyed said online portals made it easy to share patient information with other doctors and allowed patients to access their medical health record with more ease than before.

Automated alerts and reminders about appointments were among the other benefits they cited at a rate of 75 percent.

Fifty-six percent of healthcare professionals said a top benefit of online portals is the ease of appointment scheduling.

Sixty-one percent of healthcare professionals said they would recommend telehealth visits to patients at least some of the time.

More than half of healthcare professionals said they found it useful to be able to access the information collected by patients' wearable devices.

The digital health movement is growing rapidly. Almost everyday we hear of new technology, apps and ideas that bring the promise of improved medical care, health and wellness. From hand-held ultrasound devices to smart phone arrhythmia monitoring, the digital health movement isn’t only about expensive pedometers and the ‘gym elite’ but about key areas in health and wellness that will have a direct impact on medical care. Pharma–for better or worse–has a seat at this table.

Concept and Illustration: Peter Zamiska

Yet there seems to be a bit of a disconnect between pharma and many of the innovations that are emerging. Perhaps it’s the very nature of these innovations that conflicts with the conservative pharmaceutical industry. Perhaps it’s still a period of ‘watchful waiting’. Or even, it could be yesterday’s brand managers, sales reps and administrators who, while caressing the piles of pills that define an industry, are just missing what many define as the next revolution since the personal computer.

Whatever the case, there are many compelling reasons for pharma to embrace digital health. If not for today, certainly in the not so distant future.

The future of medical practice and pharmaceutical selling

The pressures on the practice of medicine are numerous. From healthcare reform to the tsunami of clinical information and data, today’s providers are looking for ways to care and to cope. Technology is an essential part of the solution. And digital health is a central part of this equation. The touch points for pharma are numerous and represent areas for engagement and support. On demand information and analytics will shift the focus from bed side ‘rote memorization’ to “augmented digital expression” where a differential diagnosis and interventions come with the aid of a hand-held computer screen. Further, the looming role of the electronic medical record will also set into motion a transformation from paper to electrons will catalyze the digital health movement and accelerate adoption. Many of these changes are happening now as a new generation of medical students begin to use their smart phones at bedside as a diagnostic and therapeutic tool with the same zeal as yesterday’s physicians who clung to their stethoscopes as validation of their clinical acumen.

The traditional role of the sales rep must also change. The consultative nature of the brand detail will shift in parallel with the technology-driven changes in practice. Pressing the flesh will transform to clinking a link and clinicians will adopt the conventions of today’s consumers and seek information in a controlled on-line setting. But perhaps more importantly, the days of typical case studies and efficacy charts will be replaced with a richer and more compelling presentation that are consistent with what this ‘techno’ generational will simply expect. And the experts themselves will change too–the standard practice of expert professorial engagement and peer to peer influence may be enhanced by none other than IBM IBM +1.92%‘s Watson and other ‘electronic’ thought-leaders.

Patients and caregivers will play an important role in the evolution of healthcare and digital health. The emergence of “citizen scientists” who are empowered by increasingly focused and filtered information will act–alone and with like-minded people–to take greater control of care. Self-advocacy will change ‘population-based’ treatment guidelines to more personalized care. And the pandering “ask your doctor” headlines of DTC advertisements will shift to data-based claims that empower the patient and make a much stronger and direct link between the pharmaceutical industry and the true end-user, not the physician.

Maybe it’s digital narcolepsy?

Whatever the cause, pharma needs to take notice. The cases studies and talking points that drive a traditional brand detail must be rethought and redefined in the context of tomorrow’s clinical reality. A reality that’s actually happening today.

2014 was the most exciting year in digital health since 2000, when the human genome was cloned. In February 2001, The Human Genome Project and Craig Venter’s Celera Genomics published the hallmark event. What followed was over a decade of glimmers of the potential for personalized medicine and new insights into disease, but also realistic mitigations in expectations, as is wont to happen in health care.

There is every indication that the next decade will be different — there will be an acceleration in innovation and development of devices to assess our healthy and ailing selves. What happened in 2014? A huge increase in funding and corporate investment in digital health technology (e.g., mobile, social media, genetics and big data), and massive growth in the accessible population, and the amount of open data:

Funding in digital health startups, tracked by an accelerator Rock Health since 2011, has grown steadily at double digit growth until this past year, when records were shattered with $4.1B in funding, more than double the 2013 amount.

Almost every major consumer technology company announced a large health initiative, notably Google, Apple, and Samsung.

Electronic health record and sensors were positioned to join or actually entered the “Internet of Things”. The partnership between Apple and Epic alone could reach 20 percent of patients entering a health care system in the U.S. An estimated 10M activity monitor units were sold in 2014 and phones became personal health monitors with the release of Apple’s HealthKit and Google’s Google Fit.

Lastly, the number of large data sets that opened in health care and the tools to analyze them came of age in 2014. For example, the FDA launched openFDA in June 2014, which made it easier to analyze data about adverse events, drug and medical device recalls, prescription and over the counter product labeling, and to access open source code for analyzing this data.

What does this mean for our health? Funding will help drive innovation, and greater connectivity between patients and the people and systems that deliver their care will help drive efficiencies. Both of these will enable developers to more easily amass huge data sets to advance personalized diagnosis and treatment, and support efforts to prevent disease.

Innovation. The last five years have been a “wild west” of digital health startups with greatly varying business rationales and user adoption. We are now beginning to see some sound inventions that make economic sense and will be used by patients, providers, and systems. Activity monitors will go stealth, such as the contact lens being developed by Google and Novartis that detects blood glucose levels. Quantification of conditions will advance so that we have a better understanding of the level and type of disease we are dealing with, such as Oculogica’s brain injury detection system for concussion and other brain afflictions. (Disclosure: The author is a consultant to Oculogica.)

Efficiencies. One of the most needed, but most difficult to realize, implications of health care systems partnering with technology companies, are changes that reduce time and costs for health care systems and patients — from the simple check in at a clinic or hospital, to the number and nature of tests ordered, to smarter follow-up. For example, the first Epic Apple integration at Ochsner Health System in Louisiana estimated a 40 percent decrease in readmissions based on a pilot study with 100 heart failure patients.

Personalization and outcomes. 2014 won’t be the end of guidelines and recommendations based on the general population, but we are at a turning point to eventually achieve ubiquitous genomic assessments of individuals and prediction for optimal treatment. The interim step will be larger data sets — ideally from clinical records and recorded from sensors — which will allow segmentation of patients by age, gender, stage of disease, and other factors. This enables providers to tailor care based on individuals or small segments, rather than large swaths of the population.

Prevention. Prevention is the holy grail in health care with significant impact on health and cost. Programs have been difficult to implement because adoption has been too onerous. Return on investment is difficult to quantify and is often not realized by one hospital or payer. Less obtrusive sensors and more connected systems lower or even remove barriers to adoption. Return on investment will be more quantifiable as individuals, rather than health systems, are followed and quantified.

What do we need in health care? Fewer people who get ill in the first place. When they do, they should receive better care, tailored to who they are and the specifics of their disease, delivered at a lower cost. The challenges notwithstanding, we moved a step closer to this fantastic vision for health care in 2014.

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